The new technology it generates will affect many people who were not previously candidates for hair restoration due to insufficient donor hair.

By: Ken Washenik, M.D., Ph.D.

The methodology of hair restoration has progressed from skin-based transplantation (with “plugs” containing several follicles) to folliclebased transplantation. The next step will be cell-based.

Everyone is born with about 100,000 hairs on their head. We gradually lose them over time and cannot currently increase their number.

Recent, on-going research into the multiplication of follicle progenitors is a field of science called “tissue engineering.” The new technology it generates will affect many people who were not previously candidates for hair restoration due to insufficient donor hair. The process is known by laymen as “hair multiplication” or “hair cloning.” From a small piece of tissue, potentially thousands of hair seeds can be grown (follicle progenitors) in the lab. These “hair seeds” will then be planted in the scalp most likely by injection. The procedure will be an adjunct to traditional follicle-based transplantation and not a complete substitute for it. Hairline recreation most likely will still be done by follicular unit transplantation with density added through hair multiplication technology.

We are in a historically significant time when it comes to treating male and female pattern hair loss. A number of effective, viable treatment options exist from a topical solution to a systemic oral medication for men to improved, more precise and natural looking surgery. The first step, however, remains the same. To determine the correct course of treatment, seek the opinion of a hair loss expert. Only after seeing a physician can you be sure of the specific cause of your alopecic condition.

Currently the state of medical knowledge is more complete when it comes to understanding the cause of pattern hair loss and appropriate treatment options. In both cases, however, if you have an intact area of hair on your scalp that has not been affected by the process of follicular miniaturization and there is a focal area of loss such as in the temples or hair line, moving follicles from to the area of loss can provide a lifetime of hair in this preferred location.

For men and women, topical minoxidil solution can help slow down the follicular miniaturization process. Finasteride for men is often an easier treatment because it only involves taking one pill each day. In contrast, minoxidil requires the manual application of a liquid to your scalp. Although effective, many find this daily regimen to be difficult. As with any medication (and arguably more so with a chronic medication that you will likely want to continue for years), see a physician experienced in the use of these medications to discuss any side-effects and their appropriateness for your condition.

The most disappointing aspect of the current medical regimens is their lack of durability of response. Over time, both topical minoxidil and systemic finasteride have been shown to demonstrate a gradual decrease in effectiveness (i.e., after 4 months and after 2 years, respectively). This is not a reason to delay starting treatment. Rather, it is more a reason to start treatment earlier when you have experienced less hair loss and to consider starting combination therapy. Consult your doctor to see if this treatment regimen may be right for you.

To date, the longest lasting treatment option remains a hair transplant procedure due to the concept of “donor dominance.” This principle indicates that transplanted hair will likely last as long in the area of balding where it has been moved to conceal it as it would have if left in its original location on the back or sides of your head. This is especially true in the hair line and temple regions where a cosmetically impactful increase in hair density is unlikely with the medications currently available. Here, too, consider combining treatments. A medication may slow down the continuing loss of the thinning hair while surgery can be used to replace thicker, more robust hairs in areas where you have already experienced significant loss. In other words, put hair where you want it with hair restoration surgery and increase your chances of holding onto hair that you haven’t yet lost using medication.

I am hopeful that treatments that can produce even greater density than can now be accomplished will become available within the not –too-distant future. In the mean time, the majority of patients with inherited, patterned hair loss can be helped with the current medications and surgical techniques.

About the Author:
Ken Washenik, M.D., Ph.D. is a Medical Director at Bosley and a Faculty Member at New York University School of Medicine, Department of Dermatopharmacology.